Operations Manager
1 week ago
Blue Shield of California is seeking a highly skilled Manager of Operations to join our Appeals and Grievances team. As a key member of our leadership team, you will be responsible for resolving member concerns through a regulated process, ensuring accurate, timely, and compliant responses.
Key Responsibilities- Provide leadership and support to your team, interacting with members, specialty clients, and regulators.
- Develop and present updates on case activity, discussing trends and observations with regulators.
- Serve as a primary speaker for regulatory audit activity.
- Lead a team, department, or functional area, overseeing planning, cost management, and methods.
- Demonstrate BSC Leadership Behaviors, fostering a great place to work and building successful relationships across the organization.
- Direct and control the activities of one or more smaller/less complex departments or functional areas through subordinate supervisors/team leads.
- Establish operational objectives for your department or functional area and participate in establishing group objectives.
- Ensure team processes are efficient and effective to manage case work timely and accurately.
- Improve quality results through training and oversight.
- Establish audit readiness across your team and in partnership with your peers.
- Trend top drivers of appeals and grievances, working with upstream and downstream partners to reduce member pain points.
- Make moderate to significant improvements within the department by partnering with training and other key stakeholders.
- Requires a college degree or equivalent experience and minimum 7 years prior relevant experience, including 3 years of management experience.
- Understands basic management approaches, including work scheduling, prioritizing, coaching, and process execution.
- Has functional expertise within the area of responsibility.
- Requires advanced knowledge of job area, usually obtained through advanced education combined with experience.
- Strong knowledge of the Appeals and Grievances process.
- Experience interacting directly with healthcare regulators.
- Regulatory audit experience.
- Acumen to handle complex situations and multiple responsibilities simultaneously.
- Ability to present information clearly and concisely to various audiences.
The pay range for this role is $96,500 to $144,800 for California.
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.
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